Professional Documents
Culture Documents
DOI 10.1007/s10802-008-9234-8
Introduction
Early prevalence studies based on small samples indicate
that ASD affects between 36 and 48 children per 10,000
(Ehlers and Gillberg 1993; Kadesjo et al. 1999), however
recent reviews are more conservative (2.6 per 10,000;
Fombonne 2007). ASD often produces difficulties with
conversation and formation of friendships (Asperger 1944,
1979). Children with ASD have particular difficulty
understanding and using the rules governing social behaviors (Wing 1981, 1992) and with using and interpreting
nonverbal social and conversational cues (Ehlers and
Gillberg 1993; Gillberg and Gillberg 1989; Szatmari et al.
1989). Children with ASD may be over-literal in interpretation (Ehlers and Gillberg 1993), often display intense
preoccupations with narrowly specific interests (Attwood
2003; Myles et al. 2001), and may have ritualized behavior
and experience distress at small changes to routine (Attwood
2006). Hyper- or hypo-sensitivity to auditory, olfactory,
tactile, or visual stimuli are also commonly reported
(Dunn et al. 2002; Rogers and Ozonoff 2005) and there
may be motor coordination problems (Gillberg and Gillberg
1989).
Under the ASD umbrella is included Autistic disorder,
Asperger disorder (commonly considered equivalent to
high functioning autism; Gilchrist et al. 2001; Mayes and
Calhoun 2001), and Pervasive Developmental Disorder Not
Otherwise Specified (PDDNOS; DSM-IV-TR; APA 2000).
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Method
Sample
All children included in the study had been referred to two
clinics specializing in pervasive developmental disorders
for diagnostic assessment because their caregiver/s or
teacher/s suspected that the child had ASD. Children were
included in the study if they had received an ASD diagnosis
[Autistic disorder (n=76), Asperger disorder (n=188),
PDDNOS (n=21)]. The sample also included a small
number of referred children who had elevations in social
cognitive dimensions of the ASASD (see Measures; Garnett
et al. 2008, manuscript under review) relative to a normal
control group [greater than two standard errors above the
normal control) but who were not diagnosed as having
ASD (n = 37). This group was included because (a)
differential ASD diagnosis was not central to this study
and we conceived ASD symptomatology as varying from
low severity (i.e., subclinical) to high severity (i.e., as is
often the case with Autistic disorder), (b) maximal variance
in ASD symptomatology was needed to detect relationships
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Diagnostic Process
The sample of parents received a formal diagnosis of their
child from one of two experienced clinicians using DSMIV-TR criteria for Autistic disorder, and the Gillberg and
Gillberg (1989) criteria for Asperger disorder. Gillbergs six
criteria comprise social impairment, narrow interests,
repetitive routines, speech and language peculiarities,
nonverbal communication problems and motor clumsiness.
Gillbergs criteria were used for Asperger disorder diagnosis in preference to other criteria/diagnostic systems
because these criteria are the longest standing criteria in
prevalence studies (Leekam et al. 2000), they are widely
used in the research literature on Asperger disorder, the
criteria include behavioural features covered in other
criterion systems (Szatmari et al. 1989; Tantam 1988), and
these criteria are closest to Aspergers own case-based
research (Asperger 1944/1991). The clinicians (XX and
YY) had 30 years and 12 years experience respectively in
the diagnosis and treatment of ASD.
Diagnoses followed a semi-structured diagnostic interview of 1-h duration conducted by one expert with the child
and primary caregiver/s, observation of the child in the
clinic, review of previous reports written by health
professionals and school personnel, and, in some cases,
interview with the class- or learning support teacher. The
semi-structured interview closely followed the structure of
the ADI-R (Lord et al. 1997), which is designed to assist in
the ASD diagnosis for children with a mental age of around
18 months through to adulthood. Agreement on each
diagnosis was checked by review of assessment notes by
the second diagnostician and/or agreement following joint
interview of the child/parents. In cases where the diagnoses
were unclear, diagnostic status was discussed, and the
family excluded if diagnostic agreement could not be
reached. Participants were included if the identified child
was between 6 and 16 years of age and parents gave
consent. Participants were excluded if the child/adolescent
was currently receiving hospital treatment as in in-patient,
or if there was a dual diagnosis of Asperger disorder and
schizophrenia
Recruitment of Participants
The research complied with the requirements of the Internal
Review Board, The University of Queensland, Australia. All
children and adolescents in the study were recruited through
the client base of two clinics (Minds and Hearts: A specialist
clinic for Asperger Syndrome and Autism) specializing in
ASD. Demographic and diagnostic information from past
client lists were reviewed by the clinic directors and 1,100
cases met criteria for potential inclusion in the study.
Attempts were made to contact all families by telephone. In
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script under review) was used to measure ASD symptomatology. The ASASD consists of 46 items measuring five
dimensions of ASDunderstanding emotion, perspective
taking, sensory sensitivity, cognitive and behavioral rigidity, and fact-orientation (7-point Likert Scale rating from 0
much less than a typical child to 7 much more than a
typical child). This measure is completed by the target
childs parents. The five individual scales show a clear
factor analytic structure, load highly and uniformly on a
second-order factor ASD symptomatology, and the subscales strongly differentiate children with ASD from nonclinic children (omitted for masked review). The intraclass
correlation coefficients (ICC) for 2-week retest data (Griffin
and Gonzalez 1995) are generally high [ICC (fact oriented)=
0.83, ICC (sensory sensitivity)=0.84, ICC (perspective
taking)=0.85, ICC (rigidity)=0.90, ICC (understanding
emotion)=0.52, and the ASAS-R total score (ICC=0.86).
The ASAS-R correlates well (r=0.56) with a theoretically
related and established measure, the Autism Spectrum
Screening Questionnaire (Ehlers et al. 1999), and three of
the subscales scores (understand emotion, fact-oriented,
and sensory sensitivity) and total score are significantly
higher for children with ASD compared to subclinical
children after adjusting for family-wise error rate (Garnett
et al. 2008, manuscript under review). The derived measure
(observed variable) of ASD symptomatology was the
weighted total score on the ASASD. Weightings for the
five factors were based on factor analyses reported
elsewhere (omitted for masked review) and were 0.50 for
understand emotion, 0.48 for fact oriented, 0.52 for sensory
sensitivity, 0.65 for perspective taking, and 0.63 for rigidity.
Family relationship variables To measure conflict and
cohesion, the two so-named subscales of the Family
Environment ScaleReal Form (FES-R; Moos and Moos
1994) were used. The two subscales each consist of nine
items (e.g., conflict subscale: We fight a lot in our
family, Family members sometimes get so angry they
throw things; cohesion subscale: Family members really
help and support one another, There is plenty of time
and attention for everyone in our family) and items are
rated as true or false. Coefficient alphas for cohesion and
conflict are 0.69 and 0.70, and confirmatory factor
analysis of the six key subscales show moderate to high
factor loadings and good fit (Sanford et al. 1999). The
convergent validity of the cohesion and conflict subscales is
indicated by significant correlations with a range of
established measures of related constructs [e.g., the Family
Adaptability and Cohesion Evaluation Scale (Olson et al.
1982) and the Conflict Tactics Scale; Straus 1979)]
(Sanford et al. 1999). The derived measures of conflict
and cohesion were the total scores for each of these
subscales.
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Peer relationship variables Positive peer relationship quality was measured using the Spence Social Competence
QuestionnaireParent Form (SCQ; Spence 1995), which
consists of a 9-item scale assessing the extent of rewarding
social relationships (e.g., has at least one close friend, has
good relationships with classmates). Questions are rated
on a 3-point scale (0 not true, 1 sometimes true, and 2
mostly true). The derived measure of positive peer
relationships was the total score on this measure. The
SCQ was standardized on Australian parents of children
and adolescents, and it has high internal consistency
(coefficient alpha=0.81; Spence 1995).
The Bullying and Teasing Questionnaire (BTQ) was
developed by the authors on the basis of Rigbys (1996)
formulation of bullying and teasing. The BTQ consists of
15 items measuring the extent to which the child is
victimized, engages in victimization, and copes with
victimization (five items each). Parents rate how often the
child is subject to/perpetuates/copes with physical bullying,
name calling, sexual harassment, deliberate exclusion, and
cruel teasing (four-point scale from 0 rarely or never to 4
very often. Our research indicates that the scale has
excellent internal consistency (=0.93) and good convergent validity. The derived measure of peer victimization
was based on the total score for the first and third subscales.
Anxiety/depression The emotion subscale of the Strengths
and Difficulties QuestionnaireParent Form (SDQ-P:
Goodman 2001) was used as the derived measure of
anxiety/depression. The emotion subscale consists of five
items (e.g., many worries, often seems worried, often
unhappy, down-hearted, or tearful) each rated on a threepoint scale (0 not true, 1 somewhat true, 2 certainly
true). Developed for assessing the psychological adjustment of 316 year olds (Goodman 2001), the SDQ-P has
adequate inter-rater reliability (r=0.62), internal consistency was adequate (=0.67), and emotion subscale scores
correlate with DSM-IV diagnoses of anxiety/depression
(Goodman 2001). This measure was used in preference to
the widely-used and validated Child Behavior Checklist
(CBCL; Achenbach 1991) because the SDQ appears at least
as good as the CBCL in detecting internalizing problems
(e.g., anxiety/depression) but has far fewer items (Goodman
and Scott 1999). [Notethe SDQ has a peer problems
subscale but this was not used to measure peer victimization because this subscale has poor internal consistency
(0.41; Goodman 2001)].
Other Measures
Formal intelligence testing was not conducted because 92%
(n=296) of children had previously completed some form
of intelligence assessment by a health/education professional (based on parents reports) and resources precluded
such large scale IQ testing within the clinic (23 h per
child). For the purposes of this research, a derived measure
of intellectual impairment was based on the presence/
absence of a formal IQ test score of less than 70 as reported
by the parent. For children who had not previously
conducted an IQ test, intellectual impairment was based
on language impairment scores (see below). An imputed
value of intellectual impairment (coded 1) was used if
language scores were in the bottom half of the distribution
of language impairment scores. For the purposes of
controlling for the potential confound of language impairment, a short measure was developed for use in this study.
The derived measure of language impairment consisted of
the total score from five supplementary questions (yes/no)
that assessed whether the child had speech, whether the
child used two to three word utterances only, had immature
grammar and syntax, and/or poor comprehension of
language. Parents reported on the presence or absence of
an ASD diagnosis for themselves or their partner, and for
other siblings. From these reports, two derived measures
were createdpresence of ASD diagnosis in one or both
parents (yes/no), and presence of ASD diagnosis in one or
more siblings of the identified child (yes/no). Socioeconomic status was measured using a revised form of
Congalten and Daniels (1976) seven-point Likert scale,
which ranges from 1 unemployed to 7 professional. This
scale is a reliable and valid index of the SES of Australian
families (Kelly et al. 2006).
Statistical Procedure
Hypotheses 14 were tested using structural equation
modeling (AMOS 6.0, SPSS 2005). To conduct these tests,
a model building approach was used. The model building
moved from simple to complex. Nonsignificant pathways
between observed/unobserved were removed from all later
complex models on the basis that respecification to a
simpler form is justified when pathways are nonsignificant.
Secondary variables (i.e., potential confounds not central to
the hypotheses) included age of child, intellectual impairment (1 present 0 absent), language impairment, siblings
with ASD (0 no siblings with ASD 1 one or more), and
gender (1 male 2 female) were included as observed
variables in all models (parental ASD diagnoses were not
included in any model because this variable was unrelated
to ASASD total score). Where paths involving secondary
variables were not significant, these were deleted from each
of the final models in the interests of model parsimony.
Model A included the observed variable ASD symptomatology and anxiety/depression, with error terms specified for each variable and secondary variables (model of
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Results
Due to the design of the website it was not possible for
participants to submit questionnaires with missing values.
Participants were permitted to submit each questionnaire
separately. To test for differences in those who completed
all questionnaires (n=322) versus those who did not (n=
46), one-way ANOVAs were conducted on continuous
demographic variables, SDQ subscale scores, FES subscale
scores, and peer victimization scores. Across all these
variables there were only two significant differences
between the two groups. Noncompleters had children who
Intellectual
impairment
Gender
-.15
-.27
ASD
symptomatology
ASD
.41
.13
Anxiety/
depression
AD
.23
Family
conflict
.22
CON
Siblings with
ASD diagnosis
Intellectual
impairment
Family
cohesiveness
Gender
-.15
-.27
-.52
Gender
Intellectual
ASD
symptomatology
impairment
.41
Anxiety/
depression
-.17
.23
-.21
Family
conflict
-.27
ASD
ASD
.42
ASD
.13
AD
.12
CON
Anxiety/depression
symptomatology
Siblings with
ASD diagnosis
.13
Siblings with
AD
ASD diagnosis
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Table 1 Means (Standard Deviations in Parentheses) and Correlations between Primary and Secondary Variables (N=322)
SD
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
94.39
6.5
3.6
4.7
4.8
4.8
10.9
0.8
0.20
9.29
0.11
14.30
2.1
2.2
2.7
3.4
2.5
2.9
0.4
0.40
0.95
0.32
1.00
0.07
0.15**
0.43***
0.10
0.07
0.08
0.03
0.28***
0.09
0.19**
1.00
0.55***
0.18**
0.01
0.05
0.09
0.08
0.03
0.02
0.21***
1.00
0.24**
0.07
0.01
0.02
0.05
0.02
0.09
0.22***
1.00
0.05
0.01
0.02
0.02
0.01
0.04
0.04
1.00
0.05
0.02
0.02
0.09
0.00
0.04
1.00
0.01
0.03
0.01
0.11
0.02
1.00
0.01
0.04
0.06
0.05
1.00
0.04
0.06
0.01
1.00
0.03
0.05
1.00
0.11
**p<0.01
***p<0.001
Discussion
The results of this study go some way towards clarifying
the links between family conflict and cohesion, peer
relationships, anxiety/depression, and ASD symptomatology. There was a significant association of severity of ASD
symptomatology and anxiety/depression. Family conflict
predicted anxiety/depression, and anxiety/depression predicted severity of AS. Peer victimization weakly and
directly predicted ASD symptomatology. Family cohesion
negatively predicted anxiety/depression, but this association
was no longer significant when family conflict was
included (Model D). Positive peer relationships were
unrelated to anxiety/depression or severity of ASD symptomatology. Findings remained statistically significant
when foreseeable confounds such as child age, intellectual
impairment, gender, language impairment, and siblings
with ASD were built into the model. Post hoc analyses
found support for the hypothesis that family relationship
quality predicted ASD symptomatology but not vice versa.
The findings of this study were new in several regards.
First, this study showed that anxiety/depression and ASD
symptomatology are significantly related. While prior
research has established that anxiety/depression is common
in children with ASD, this study showed that a latent
construct of ASD symptomatology was continuously
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Conclusion
This study is a key first step in evaluating the potential
impact of family and peer relationship quality on the
symptomatology of children with ASD. Results were
consistent with the possibility that anxiety/depression is a
key conduit by which family conflict increases ASD
symptomatology, however longitudinal research is needed
to begin disentangling causal relationships. Interventions
for children with ASD may be fruitfully enhanced by
including couple/family interventions designed to manage
conflict, even when the severity/frequency of conflict is
within the range of nondistressed couples/families.
Acknowledgements The authors thank Beverlee Garnett for invaluable administrative assistance. This research was conducted during an
NHMRC Career Development Fellowship awarded to the first author.
References
Achenbach, T. M. (1991). Manual for the child behavior checklist/4
19 and 1991 profile. Burlington: University of Vermont
Department of Psychiatry.
American Psychiatric Association (2000). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, DC: American
Psychiatric Association text revision.
Apter, R., Bernhout, E., & Tyano, S. (1984). Severe obsessive
compulsive disorder in adolescence: A report of eight cases.
Journal of Adolescence, 7(4), 349358.
Asperger, H. (1944). Autistic psychopathy in childhood. In U. Frith
(Ed.) Autism and Aspergers syndrome. Cambridge: Cambridge
University Press (1991).
Asperger, H. (1979). Problems of infantile autism. Communication:
Journal of the National Autistic Society, London, 13, 4552.
Attwood, T. (2003). Understanding and managing circumscribed
interests. In M. Prior (Ed.) Learning and behavior problems in
Asperger syndrome. New York: Guilford.
Attwood, T. (2006). The complete guide to Aspergers syndrome.
London, UK: Kingsley.
Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in
high-functioning children with autism. Child Development, 71
(2), 447456.
Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and
loneliness in high-functioning children with autism. Journal of
autism and Developmental Disorders, 33(5), 489506.
1079
Benson, P. R. (2006). The impact of child symptom severity on
depressed mood among parents of children with ASD: The
mediating role of stress proliferation. Journal of Autism and
Developmental Disorders, 36, 685695.
Berthoz, S., & Hill, E. (2005). The validity of using self-reports to
assess emotion regulation abilities in adults with autism spectrum
disorder. European Psychiatry, 20, 291298.
Biederman, J., Faraone, S., & Monteaux, M. (2002). Differential effect
of environment adversity by gender: Rutters index of adversity
in a boys and girls with and without ADHD. American Journal of
Psychiatry, 159, 15561562.
Biederman, J., Milberger, S., Faraone, S., Kiely, K., Guite, J., Mick,
E., et al. (1995). Family-environmental risk factors for attentiondeficit hyperactivity disorder. Archives of General Psychiatry, 52,
464470.
Bollmer, J. M., Milich, R., Harris, M. J., & Maras, M. A. (2005). A
friend in need: The role of friendship quality as a protective
factor in peer victimization and bullying. Journal of Interpersonal Violence, 20(6), 701712.
Bolton, D., Collins, S., & Steinberg, D. (1983). The treatment of
obsessivecompulsive disorder in adolescence: A report of
fifteen cases. British Journal of Psychiatry, 142, 456464.
Bradbury, T. N., Fincham, F. D., & Beach, S. R. H. (2000). Research
on the nature and determinants of marital satisfaction: A decade
in review. Journal of Marriage and the Family, 62, 964980.
Bristol, M. (1987). Mothers of children with autism or communication
disorders: Successful adaptation and the double ABCX model.
Journal of Autism and Developmental Disorders, 17, 469486.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing
model fit. In K. A. Bollen, & J. S. Long (Eds.) Testing structural
models (pp. 136162). Newbury Park, CA: Sage.
Bukowski, W. M., Hoza, B., & Boivin, M. (1994). Measuring friendship
quality during pre- and early adolescence: The development and
psychometric properties of the friendship qualities scale. Journal of
Social and Personal Relationships, 11, 471484.
Burman, B., & Margolin, G. (1992). Analysis of the association
between marital relationships and health problems: An interactional perspective. Psychological Bulletin, 112(1), 3963.
Byrne, B. M. (2001). Structural equation modeling with AMOS: Basic
concepts, applications and programming. NJ: Erlbaum.
Cohen, S., & Wills, T. (1985). Stress, social support, and the buffering
hypothesis. Psychological Bulletin, 98, 310357.
Collins, N. L., Dunkel-Schetter, C., Lobel, M., & Scrimshaw, S. C.
(1993). Social support in pregnancy: Psychosocial correlates of
birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65, 12431258.
Congalten, A. A., & Daniel, A. E. (1976). An individual in the
making: An introduction to sociology. Sydney: Wiley.
Cutrona, C. E., & Suhr, J. A. (1994). Social support communication in
the context of marriage: An analysis of couples supportive
interactions. In B. R. Burleson, T. L. Albrecht, & I. G. Sarason
(Eds.) Communication of social support: Messages, interactions,
relationships, and community (pp. 113135). Thousand Oaks,
CA: Sage.
Dunn, W., Myles, B., & Orr, S. (2002). Sensory processing issues in
Asperger syndrome: A preliminary investigation. American
Journal of Occupational Therapy, 56(1), 97102.
duPaul, G. J., McGoey, K. E., Eckert, T. L., & Vanbrakle, J. (2001).
Preschool children with attention-deficit/hyperactivity disorder:
Impairments in behavioral, social, and school functioning.
Journal of the American Academy of Child & Adolescent
Psychiatry, 40(5), 508515.
Dumas, J. E., Wolf, L. C., Fisman, S. N., & Culligan, A. (1991).
Parenting stress, child behaviour problems, and dysphoria in
parents of children with autism, Down syndrome, behaviour
disorders, and normal development. Exceptionality, 2, 97110.
1080
Ehlers, S., & Gillberg, C. (1993). The epidemiology of Aspergers
Syndromea total population study. Journal of Child Psychology and Psychiatry, 34, 13271350.
Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire
for Asperger syndrome and other high-functioning autism
spectrum disorders in school age children. Journal of Autism
and Developmental Disorders, 29, 129141.
Fincham, F. D. (2003). Marital conflict: Correlates, structure, and
context. Current Directions in Psychological Science, 12, 2327.
Fombonne, E. (2007). Epidemiology of pervasive developmental
disorders. In J. M. Prez, P. M. Gonzlez, M. L. Com, & C.
Nieto (Eds.) New developments in autism: The future is today.
London: Kingsley.
Gabriels, R., Hill, D., Pierce, R., Rogers, S., & Wehner, B. (2001).
Predictors of treatment outcome in children with autism. Autism: An
International Journal of Research and Practice, 5(4), 407429.
Gilchrist, A., Green, J., Cox, A., Rutter, M., & Le Couteur, A. (2001).
Development and current functioning in adolescents with
Asperger syndrome: A comparative study. Journal of Child
Psychology and Psychiatry, 42, 227240.
Gillberg, C., & Gillberg, I. C. (1989). Asperger Syndromesome
epidemiological considerations: a research note. Journal of Child
Psychology and Psychiatry, 30, 631638.
Goodman, R. (2001). Psychometric properties of the strengths and
difficulties questionnaire. Journal of the American Academy of
Child and Adolescent Psychiatry, 40(11), 13371345.
Goodman, R., & Scott, S. (1999). Comparing the strengths and
difficulties questionnaire and the child behavior checklist: Is small
beautiful? Journal of Abnormal Child Psychology, 27, 1724.
Griffin, D., & Gonzalez, R. (1995). Correlational analysis of dyad-level
data in the exchangeable case. Psychological Bulletin, 118, 430439.
Halford, W. K., Osgarby, S., & Kelly, A. B. (1996). Brief cognitive
behavioural couples therapy: A preliminary investigation. Behavioural and Cognitive Psychotherapy, 24, 263273.
Happ, F., & Frith, U. (1996). The neuropsychology of autism. Brain,
119, 13771400.
Harrison, J., & Hare, D. (2004). Brief report: Assessment of sensory
abnormalities in people with autistic spectrum disorders. Journal
of Autism and Developmental Disorders, 34, 727730.
Hawker, S. J., & Boulton, M. J. (2000). Twenty years of research on
peer victimization and psychosocial maladjustment: A metaanalytic review of cross-sectional studies. Journal of Child
Psychology and Psychiatry, 41, 441455.
Hay, D., Payne, A., & Chadwick, A. (2004). Peer relations in childhood.
Journal of Child Psychology and Psychiatry, 45, 84108.
Hill, E., Berthoz, S., & Frith, U. (2004). Cognitive processing of own
emotions in individuals with autistic spectrum disorder and in
their relatives. Journal of Autism and Developmental Disorders,
34, 229235.
Howard, B., Cohn, E., & Orsmond, G. I. (2006). Understanding and
negotiating friendships: Perspectives from an adolescent with
Asperger syndrome. Autism, 10(6), 619627.
Howlin, P. (2003). Outcome in high-functioning adults with autism
with and without early language delays: Implications for the
differentiation between autism and Asperger syndrome. Journal
of Autism and Developmental Disorders, 33(1), 313.
Iwanaga, R., Kawasaki, C., & Tsuchida, R. (2000). Brief report:
Comparison of sensory-motor and cognitive function between
autism and Asperger syndrome in preschool children. Journal of
Autism and Developmental Disorders, 30, 169174.
Kadesjo, B., Gillberg, C., & Hagberg, B. (1999). Autism and Asperger
syndrome in seven-year-old children: a total population study.
Journal of Autism and Developmental Disorders, 29, 327331.
Kamps, D., Royer, J., & Dugan, E. (2002). Peer training to facilitate
social interaction for elementary students with autism and their
peers. Exceptional Children, 68(2), 173178.
1081
Solomon, M., Goodlin-Jones, B. L., & Anders, T. F. (2004). A social
adjustment enhancement intervention for high functioning autism, Asperger's syndrome, and pervasive developmental disorder
NOS. Journal of Autism and Developmental Disorders, 34(6),
649668.
Spence, S. (1995). Social skills training: Enhancing social competence with children and adolescents. Windsor: NFER-Nelson.
SPSS (2005). Statistical package for the social sciences version 14.0
and AMOS version 6.0 [Computer Software]. Chicago, Illinois:
SPSS.
Straus, M. (1979). Measuring intrafamily conflict and violence: The
conflict tactics scales. Journal of Marriage and the Family, 35,
7588.
Szatmari, P., Bremner, R., & Nagy, J. (1989). Aspergers syndrome: A
review of clinical features. Canadian Journal of Psychiatry, 34,
554560.
Tani, P., Joukamaa, M., Lindberg, N., Nieminen-von Wendt, T.,
Virkkala, J., Appelberg, B., et al. (2004). Asperger syndrome,
alexithymia and sleep. Neuropsychobiology, 49, 6470.
Tantam, D. (1988). Annotation: Aspergers syndrome. Journal of
Child Psychology and Psychiatry, 29, 245255.
Tonge, B. J., Brereton, A. V., Kiomall, M., MacKinnon, A., King, M.,
& Rinehart, N. (2006). Effects on parental mental health of an
education and skills training program for parents of young
children with autism: A randomized controlled trial. Journal of
the American Academy of Child and Adolescent Psychiatry, 45
(5), 561570.
Toro, J., Cervara, M., Osejo, E., & Salamero, M. (1992). Obsessive
compulsive disorder in childhood and adolescence: A clinical
study. Journal of Child Psychology and Psychiatry, 33(6), 1025
1037.
Vert, S., Geurts, H. M., Roeyers, H., Oosterlaan, J., & Sergeant, J. A.
(2006). Executive functioning in children with an autism
spectrum disorder: Can we differentiate within the spectrum?
Journal of Autism and Developmental Disorders, 36, 351372.
Weidle, B., Bolme, B., & Hoeyland, A. L. (2006). Are peer support
groups for adolescents with Asperger's syndrome helpful?
Clinical Child Psychology and Psychiatry, 11(1), 4562.
Willey, L. H. (2001). Asperger syndrome in the family: Redefining
normal. London: Kingsley.
Wing, L. (1981). Aspergers syndrome: A clinical account. Psychological Medicine, 11, 115129.
Wing, L. (1992). Manifestations of social problems in high-functioning autistic people. In E. Schopler, & G. B. Mesibov (Eds.) Highfunctioning individuals with autism. New York: Plenum.